Provide full information of any lease premises, including full address.

Number of Club Members

Provide Limit Required

Select Limit Required

$500,000 per occurrence/$1,000,000 annual aggregate

$1,000,000 per occurrence/$2,000,000 annual aggregate

Excess over $1,000,000 required (Provide Limit below)

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED ENTRIES FOR EVENT

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

ADD ANOTHER EVENT

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED SPECTATORS PER DAY

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

ADD ANOTHER EVENT

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED SPECTATORS PER DAY

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

ADD ANOTHER EVENT

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED SPECTATORS PER DAY

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

ADD ANOTHER EVENT

Provide details of any Event held by your Club:

TYPE OF EVENT

LOCATION OF EVENT:

Address

City

State

Zip Code

EVENT DATES:

ESTIMATED SPECTATORS PER DAY

IS SHOW SANCTIONED BY ANY NATIONAL ASSOCIATION?

SANCTIONING ORGANIZATION:

Provide Competition Number

Name of Organization

Address

City

State

Zip Code

ADDITIONAL INSURED(S) FOR EVENT

Address

City

State

Zip Code

Are dogs allowed at Event?

What restrictions are required for dogs?

Is alcohol permitted at your Events?

Describe

Is alcohol sold, serve or furnished at your Events?

Describe

Do you currently have an Equine Liability Policy?

Yes

No

Any prior losses?

Yes

No

Name of Insurance Company

Expiration date of current policy

Comments / Questions

ABOUT SMITH-EMBRY

Smith-Embry Insurance Associates, Inc. offers a full line of equine insurance products. Please contact us to discuss your equine insurance needs. We are happy to advise you on your individual and/or business insurance needs…….Learn More

"Beverly has always been there for me and my horses I feel blessed to know she is always available even when she is on vacation . Knowing I can contact her when I need her gives me much comfort. "

Missy Head, Rainmaker Arabians

“I have used Smith-Embry Insurance for over ten years. Beverly and her team are consummate professionals whom I can trust to have my best interests at heart. Whenever you need her, she is responsive and does her best to make what can be an unpleasant task easier.”

Jeanne Abernathy, Brookhill Farm

"In 20 years of working with Beverly and her staff , I have never been disappointed! They are the ultimate professionals!!"